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Saragih ID, Tonapa SI, Osingada CP, Porta CM, Lee BO. Effects of telehealth-assisted interventions among people living with HIV/AIDS: A systematic review and meta-analysis of randomized controlled studies. J Telemed Telecare 2024; 30:438-450. [PMID: 34967240 DOI: 10.1177/1357633x211070726] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Taking antiretroviral therapy (ART) is a daily necessity for people living with HIV but these individuals experience multiple barriers and challenges to medication adherence. Interventions to support medication adherence have yielded effects in the expected direction, but the extent to which telehealth or virtually delivered interventions to promote adherence are effective among people living with HIV/AIDS remains unknown. We aimed to address this knowledge gap and inform future research and practice that promotes the well-being of people living with HIV/AIDs through telehealth interventions addressing medication use. METHODS A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted using the following databases: Academic Search Complete, Cochrane library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, MEDLINE, PubMed, OVID (UpToDate), and the Web of Science. Relevant full-text articles published through September 2021 were retrieved. The revised Cochrane risk of bias tool for randomized trials was used to assess the methodological quality of the included studies. A meta-analysis was performed using a random-effects model to calculate the pooled effects of telehealth-assisted interventions for people living with HIV/AIDS. Stata 16.0 was used for statistical analysis. RESULTS A total of 12 studies (N = 3557 participants) that used telehealth-assisted interventions for people living with HIV/AIDS were included. Telehealth interventions were found to increase the adherence to treatment (standardized mean difference [SMD]: 0.21; 95% confidence interval (CI): 0.03 to 0.40), to reduce depressive symptoms (SMD: -2,74; 95% CI: -3.39 to -2.09), and to improve perceived quality of life (SMD: 0.74; 95% CI: 0.37 to 1.10). DISCUSSION The meta-effects of telehealth-assisted interventions include significantly enhanced adherence to treatment, improved quality of life, and reduced depressive symptoms among people living with HIV/AIDS. These findings suggesting that delivering health management interventions remotely through telehealth-assisted modalities was both feasible and effective in yielding health benefits for people living with HIV/AIDS. Integrating telehealth-assisted interventions as a modality in HIV/AIDS care might support continuity of care and sustained well-being. Future research should evaluate telehealth intervention outcomes and examine mediating, moderating, or other tailorable variables affecting intervention effectiveness.
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Affiliation(s)
| | - Santo Imanuel Tonapa
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
- School of Nursing, Sam Ratulangi University, Manado, Indonesia
| | | | - Carolyn M Porta
- School of Nursing, University of Minnesota, Minneapolis, USA
| | - Bih-O Lee
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
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Hird R, Radhakrishnan R, Tsai J. A systematic review of approaches to improve medication adherence in homeless adults with psychiatric disorders. Front Psychiatry 2024; 14:1339801. [PMID: 38260790 PMCID: PMC10800888 DOI: 10.3389/fpsyt.2023.1339801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 12/19/2023] [Indexed: 01/24/2024] Open
Abstract
Introduction Medication non-adherence is a significant problem among homeless individuals with psychiatric disorders in the United States. We conducted a systematic review to identify strategies to improve psychiatric medication adherence among homeless individuals with psychiatric disorders, including substance use disorders. Methods We searched seven databases (MEDLINE, Embase, PsychInfo, Scopus, Web of Science, CDSR, and CENTRAL) and screened 664 studies by title and abstract followed by full-text review. Our inclusion criteria were studies that: involved an intervention for homeless adults with psychiatric disorders, reported a quantitative outcome of medication adherence, and were published in English in a peer-reviewed journal. We rated the relative effectiveness of strategies described in each study using a self-designed scale. Results Eleven peer-reviewed studies met criteria for inclusion in this review. Within these studies, there were seven different approaches to improve medication adherence in this population. Three studies were randomized controlled trials (RCTs) and the remaining were observational studies. Outpatient interventions included Assertive Community Treatment, Cell Phone-Assisted Monitoring, Customized Adherence Enhancement plus Long-Acting Injectable Medications, and Homeless-Designated Pharmacy Clinics. Residential, shelter-based, and inpatient interventions included use of the Housing First model, Modified Therapeutic Communities, and Homeless-Designated Inpatient Care. The approaches described in four of the eleven studies were rated as scoring a 3 or higher on a 5-point scale of effectiveness in improving medication adherence; none received 5 points. Discussion The interventions with the strongest evidence for improving medication adherence in this population were Assertive Community Treatment, Customized Adherence Enhancement plus Long-Acting Injectable Medications, and Housing First. Overall, studies on this topic required more rigor and focus on medication adherence as an outcome in this population. This review highlights several promising strategies and the need for larger RCTs to determine effective and diverse ways to improve medication adherence among homeless adults with psychiatric disorders.
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Affiliation(s)
- Rachel Hird
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States
| | - Rajiv Radhakrishnan
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, United States
| | - Jack Tsai
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States
- Department of Veterans Affairs, National Center on Homelessness Among Veterans, Washington, DC, United States
- School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, United States
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Morris MD, McDonell C, Kim RG, Laguardia Y, Kanner R, Price JC. A pilot study to understand and respond to loss, theft, and misplacement of hepatitis C treatment medication for people who inject drugs. Clin Liver Dis (Hoboken) 2023; 22:81-84. [PMID: 37799636 PMCID: PMC10550011 DOI: 10.1097/cld.0000000000000042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 03/09/2023] [Indexed: 10/07/2023] Open
Abstract
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Affiliation(s)
- Meghan D. Morris
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Claire McDonell
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Rebecca G. Kim
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Yesenia Laguardia
- Division of Gastroenterology and Hepatology, Department of Medicine, University of California San Francisco, San Francisco, California, USA
- Liver Center, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Rachel Kanner
- Division of Gastroenterology and Hepatology, Department of Medicine, University of California San Francisco, San Francisco, California, USA
- Liver Center, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Jennifer C. Price
- Division of Gastroenterology and Hepatology, Department of Medicine, University of California San Francisco, San Francisco, California, USA
- Liver Center, Department of Medicine, University of California San Francisco, San Francisco, California, USA
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Avelar Portillo LJ, Kayser GL, Ko C, Vasquez A, Gonzalez J, Avelar DJ, Alvarenga N, Franklin M, Chiang YY. Water, Sanitation, and Hygiene (WaSH) insecurity in unhoused communities of Los Angeles, California. Int J Equity Health 2023; 22:108. [PMID: 37264411 PMCID: PMC10233557 DOI: 10.1186/s12939-023-01920-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 05/20/2023] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND Access to water and sanitation is a basic human right; however, in many parts of the world, communities experience water, sanitation, and hygiene (WaSH) insecurity. While WaSH insecurity is prevalent in many low and middle-income countries, it is also a problem in high-income countries, like the United States, as is evident in vulnerable populations, including people experiencing homelessness. Limited knowledge exists about the coping strategies unhoused people use to access WaSH services. This study, therefore, examines WaSH access among unhoused communities in Los Angeles, California, a city with the second-highest count of unhoused people across the nation. METHODS We conducted a cross-sectional study using a snowball sampling technique with 263 unhoused people living in Skid Row, Los Angeles. We calculated frequencies and used multivariable models to describe (1) how unhoused communities cope and gain access to WaSH services in different places, and (2) what individual-level factors contribute to unhoused people's ability to access WaSH services. RESULTS Our findings reveal that access to WaSH services for unhoused communities in Los Angeles is most difficult at night. Reduced access to overnight sanitation resulted in 19% of the sample population using buckets inside their tents and 28% openly defecating in public spaces. Bottled water and public taps are the primary drinking water source, but 6% of the sample reported obtaining water from fire hydrants, and 50% of the population stores water for night use. Unhoused people also had limited access to water and soap for hand hygiene throughout the day, with 17% of the sample relying on hand sanitizer to clean their hands. Shower and laundry access were among the most limited services available, and reduced people's ability to maintain body hygiene practices and limited employment opportunities. Our regression models suggest that WaSH access is not homogenous among the unhoused. Community differences exist; the odds of having difficulty accessing sanitation services is two times greater for those living outside of Skid Row (Adj OR: 2.52; 95% CI: 1.08-6.37) and three times greater for people who have been unhoused for more than six years compared to people who have been unhoused for less than a year (Adj OR: 3.26; 95% CI: 1.36-8.07). CONCLUSION Overall, this study suggests a need for more permanent, 24-h access to WaSH services for unhoused communities living in Skid Row, including toilets, drinking water, water and soap for hand hygiene, showers, and laundry services.
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Affiliation(s)
- Lourdes Johanna Avelar Portillo
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California (UCSD), 9500 Gilman Drive, La Jolla, CA, 92093, USA.
- Benioff Homelessness and Housing Initiative, School of Medicine, University of California San Francisco, 2789 25th Street, San Francisco, CA, 94110, USA.
| | - Georgia L Kayser
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California (UCSD), 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Charlene Ko
- Spatial Sciences Institute, University of Southern California (USC), 3616 Trousdale Parkway, Los Angeles, CA, 90089, USA
| | - Angelica Vasquez
- Spatial Sciences Institute, University of Southern California (USC), 3616 Trousdale Parkway, Los Angeles, CA, 90089, USA
| | - Jimena Gonzalez
- Spatial Sciences Institute, University of Southern California (USC), 3616 Trousdale Parkway, Los Angeles, CA, 90089, USA
| | - Diego Jose Avelar
- Spatial Sciences Institute, University of Southern California (USC), 3616 Trousdale Parkway, Los Angeles, CA, 90089, USA
| | - Nayib Alvarenga
- Spatial Sciences Institute, University of Southern California (USC), 3616 Trousdale Parkway, Los Angeles, CA, 90089, USA
| | - Meredith Franklin
- Department of Statistical Sciences, University of Toronto, 700 University Ave., Toronto, ON, Canada
| | - Yao-Yi Chiang
- Department of Computer Science and Engineering, University of Minnesota, 200 Union St. SE, Minneapolis, MN, 55455, USA
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Alqudah A, Al-Taani G, Handal D, Al Sharab R, Al Shreideh R, Al-Smadi A, Qnais E, Gammoh O. Factors Associated with Psychotropic Medications Literacy among Community Pharmacists. Medicina (B Aires) 2023; 59:medicina59030618. [PMID: 36984619 PMCID: PMC10056436 DOI: 10.3390/medicina59030618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/17/2023] [Accepted: 03/17/2023] [Indexed: 03/22/2023] Open
Abstract
Background and objectives: Community pharmacists play an important role in ensuring the patient’s adherence to medications, thus achieving therapeutic outcomes. The present study had two aims: to measure the extent of knowledge that community pharmacists had about psychotropic medications and to determine the factors associated with higher knowledge scores. Methods: A cross-sectional design was employed, using a structured online questionnaire. The study instrument assessed demographics, general practice characteristics related to psychotropics and a battery of factual questions that assessed the knowledge of pharmacists about psychotropic medications using closed-ended responses. A total knowledge score consisting of the sum of correct responses was calculated; the passing score was 75%. A total of 676 pharmacists completed the survey. Results: Only 20% passed the threshold score (75%) for the factual knowledge questions, and only (11.0%) were very comfortable with their knowledge of psychotropic agents. A total of 49.0% of the respondents felt that they had been adequately trained to counsel patients on psychotropic agents. According to the regression model, pharmacists who reported higher knowledge were more experienced (0.63, (0.26–1.0), p < 0.001), reported studying the topic in the pharmacy school (0.77 (0.27–1.26), p = 0.002) holding a Doctor of Pharmacy (Pharm D) degree (0.24 (0.05–0.43), p = 0.01), and reported a higher perceived knowledge (0.29 (0.01–0.38), p = 0.038). Conclusion: Community pharmacists reported poor knowledge of psychotropic medications, and continuous medical and professional education programs are mandatory.
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Affiliation(s)
- Abdelrahim Alqudah
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmaceutical Sciences, The Hashemite University, Zarqa P.O. Box 330127, Jordan
- Correspondence:
| | - Ghaith Al-Taani
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, Yarmouk University, Irbid P.O. Box 566, Jordan
| | - Daniel Handal
- Faculty of Psychology, Balqa’ Applied University, Al-Salt P.O. Box 19117, Jordan
| | - Rahaf Al Sharab
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, Yarmouk University, Irbid P.O. Box 566, Jordan
| | - Rawan Al Shreideh
- Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmacy, Yarmouk University, Irbid P.O. Box 566, Jordan
| | - Ahmed Al-Smadi
- Department of Adult Health Nursing, Princess Salma Faculty of Nursing, Al al-Bayt University, Mafraq P.O. Box 25113, Jordan
| | - Esam Qnais
- Department of Biology and Biotechnology, Faculty of Science, The Hashemite University, Zarqa P.O. Box 330127, Jordan
| | - Omar Gammoh
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, Yarmouk University, Irbid P.O. Box 566, Jordan
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Rangu N, Frank-Pearce SG, Alexander AC, Hébert ET, Ra C, Kendzor DE, Businelle MS. Non-adherence to psychiatric medication in adults experiencing homelessness is associated with incurred concussions. Front Hum Neurosci 2022; 16:958169. [PMID: 35966999 PMCID: PMC9366846 DOI: 10.3389/fnhum.2022.958169] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 07/13/2022] [Indexed: 11/24/2022] Open
Abstract
This study investigated the relationship between concussions and medication adherence among 247 adults experiencing homelessness in Oklahoma City, Oklahoma, who were prescribed medication for a psychiatric disorder. Participants were asked whether they had “ever experienced a blow to the head that caused a concussion,” and medication adherence was measured by asking participants whether they had taken their psychiatric medication yesterday. The data were analyzed using univariate and multivariable logistic regressions. Results showed that more than half of the sample had a concussion history (61.9%), and homeless adults with a concussion history had higher odds of non-adherence to psychiatric medications compared with those who reported no concussion history [OR = 2.13 (95% CI = 1.08, 4.18)]. Findings suggest that medication non-adherence is associated with incurred concussions. Raising awareness among service providers of the relationship between traumatic brain injury and medication adherence may increase efforts to improve adherence in this underserved population.
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Affiliation(s)
- Neal Rangu
- TSET Health Promotion Research Center, Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Sumer G. Frank-Pearce
- TSET Health Promotion Research Center, Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Adam C. Alexander
- TSET Health Promotion Research Center, Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
- Department of Family and Preventive Medicine, College of Medicine, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
- *Correspondence: Adam C. Alexander
| | - Emily T. Hébert
- TSET Health Promotion Research Center, Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
- Department of Health Promotion and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Chaelin Ra
- TSET Health Promotion Research Center, Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Darla E. Kendzor
- TSET Health Promotion Research Center, Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
- Department of Family and Preventive Medicine, College of Medicine, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Michael S. Businelle
- TSET Health Promotion Research Center, Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
- Department of Family and Preventive Medicine, College of Medicine, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
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Thurman W, Moczygemba LR, Baffoe JO. "Without my medication, I'm a wreck": Photo-elicitation to explore medication use among people experiencing homelessness. Res Social Adm Pharm 2021; 18:3149-3157. [PMID: 34479800 DOI: 10.1016/j.sapharm.2021.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 08/29/2021] [Accepted: 08/30/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND People experiencing homelessness (PEH) live with a high burden of chronic illness, functional and cognitive impairments, and serious mental illness. Many PEH are prescribed complex medication regimens to manage symptoms and improve health and functioning. However, medication use within the context of homelessness is complicated, and adherence is often suboptimal. OBJECTIVE To document medication use within the context of homelessness and explore experiences of medication use among people experiencing homelessness (PEH). METHODS This study used mixed methods including photo-elicitation interviews. Participants were given a digital camera and asked to take pictures of people, places, things, and situations that represented every day medication use. Participants were also asked to write down reasons for taking the pictures. After two weeks, participants returned the camera and notes. At a subsequent interview, the photographs and notes were reviewed and discussed. Demographic and health-related information was also collected for each participant. An interpretive description approach was used for qualitative data analysis. Quantitative data were analyzed using descriptive statistics in order to describe the sample. RESULTS Seven PEH completed this study. Mean age was 45 years (SD = 11.3) and length of homelessness was 6.1 years (SD = 11.3). All reported multiple chronic conditions (≥2) and reported taking 6.6 (SD = 2.6) medications. Participants reported medication adherence barriers with mean score of 37 (SD = 5.5) on the ASK-12, a 12-item scale with a range of 12-60 (higher scores indicate more barriers). Qualitative analysis identified four categories: medication-related burdens, medication-related beliefs, connectedness, and stigmatizing encounters. CONCLUSIONS Medication use among PEH is complex and cannot be considered separately from daily life or from struggles to meet basic needs. Multi-level interventions are needed to optimize medication use among PEH, and healthcare professionals including community pharmacists should reinforce beliefs that medication-related benefits outweigh the burdens and then tailor services to the context of homelessness.
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Affiliation(s)
- Whitney Thurman
- College of Pharmacy, Health Outcomes Division, The University of Texas at Austin, 2900 University Ave. Austin, TX, 78712, USA; School of Nursing, The University of Texas at Austin, 1710 Red River St. Austin, TX, 78701, USA.
| | - Leticia R Moczygemba
- College of Pharmacy, Health Outcomes Division, The University of Texas at Austin, 2900 University Ave. Austin, TX, 78712, USA
| | - James O Baffoe
- College of Pharmacy, Health Outcomes Division, The University of Texas at Austin, 2900 University Ave. Austin, TX, 78712, USA
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Eshtehardi SS, Taylor AA, Chen TA, de Dios MA, Correa-Fernández V, Kendzor DE, Businelle MS, Reitzel LR. Sociodemographic Determinants of Nonadherence to Depression and Anxiety Medication among Individuals Experiencing Homelessness. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18157958. [PMID: 34360251 PMCID: PMC8345659 DOI: 10.3390/ijerph18157958] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 07/11/2021] [Accepted: 07/27/2021] [Indexed: 12/03/2022]
Abstract
Psychiatric medication nonadherence continues to be a leading cause of poor health outcomes for individuals experiencing homelessness. Identifying the sociodemographic factors that contribute to medication nonadherence may help guide strategies to care for and support this group. This study examined 200 adults with depression diagnoses and active anti-depressant prescriptions (Mage = 43.98 ± 12.08, 59.4% Caucasian, 58.5% male, 70% uninsured, 89.5% unemployed) and 181 adults with anxiety diagnoses and active anti-anxiety prescriptions (Mage = 43.45 ± 11.02, 54.4% Caucasian, 57.5% male, 66.3% uninsured, 88.9% unemployed) recruited from six homeless-serving agencies in Oklahoma City. Self-reported sociodemographic variables included: age, sex, race/ethnicity, education, monthly income, employment status, and health insurance status. Adjusted logistic regression analyses revealed that employed (OR = 4.022, CI0.95: 1.244–13.004) and insured (OR = 2.923, CI0.95: 1.225–6.973) participants had greater odds of depression medication nonadherence. For anxiety, being employed (OR = 3.573, CI0.95: 1.160–11.010) was associated with greater odds of anxiety medication nonadherence, whereas having depression and anxiety diagnostic comorbidity (OR = 0.333, CI0.95: 0.137–0.810) was associated with lower odds of anxiety medication nonadherence. Interventions aimed at facilitating accessible prescription acquisition or otherwise reducing barriers to prescription medications for employed adults, including those with health insurance, may benefit adherence, but more research is needed. Future studies would benefit from using a qualitative approach to better delineate nuanced barriers to psychiatric medication adherence.
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Affiliation(s)
- Sahar S. Eshtehardi
- Department of Psychological, Health, & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA; (S.S.E.); (A.A.T.); (T.A.C.); (M.A.d.D.); (V.C.-F.)
| | - Ashley A. Taylor
- Department of Psychological, Health, & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA; (S.S.E.); (A.A.T.); (T.A.C.); (M.A.d.D.); (V.C.-F.)
| | - Tzuan A. Chen
- Department of Psychological, Health, & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA; (S.S.E.); (A.A.T.); (T.A.C.); (M.A.d.D.); (V.C.-F.)
- HEALTH Research Institute, The University of Houston, 4849 Calhoun Rd., Houston, TX 77204, USA
| | - Marcel A. de Dios
- Department of Psychological, Health, & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA; (S.S.E.); (A.A.T.); (T.A.C.); (M.A.d.D.); (V.C.-F.)
- HEALTH Research Institute, The University of Houston, 4849 Calhoun Rd., Houston, TX 77204, USA
| | - Virmarie Correa-Fernández
- Department of Psychological, Health, & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA; (S.S.E.); (A.A.T.); (T.A.C.); (M.A.d.D.); (V.C.-F.)
- HEALTH Research Institute, The University of Houston, 4849 Calhoun Rd., Houston, TX 77204, USA
| | - Darla E. Kendzor
- TSET Health Promotion Research Center, The University of Oklahoma Health Sciences Center, 655 Research Parkway, Suite 400, Oklahoma, OK 73104, USA; (D.E.K.); (M.S.B.)
| | - Michael S. Businelle
- TSET Health Promotion Research Center, The University of Oklahoma Health Sciences Center, 655 Research Parkway, Suite 400, Oklahoma, OK 73104, USA; (D.E.K.); (M.S.B.)
| | - Lorraine R. Reitzel
- Department of Psychological, Health, & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA; (S.S.E.); (A.A.T.); (T.A.C.); (M.A.d.D.); (V.C.-F.)
- HEALTH Research Institute, The University of Houston, 4849 Calhoun Rd., Houston, TX 77204, USA
- Correspondence: ; Tel.: +1-713-743-6679
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Lederle M, Tempes J, Bitzer EM. Application of Andersen's behavioural model of health services use: a scoping review with a focus on qualitative health services research. BMJ Open 2021; 11:e045018. [PMID: 33952550 PMCID: PMC8103375 DOI: 10.1136/bmjopen-2020-045018] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 04/02/2021] [Accepted: 04/06/2021] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Qualitative methods have become integral in health services research, and Andersen's behavioural model of health services use (BMHSU) is one of the most commonly employed models of health service utilisation. The model focuses on three core factors to explain healthcare utilisation: predisposing, enabling and need factors. A recent overview of the application of the BMHSU is lacking, particularly regarding its application in qualitative research. Therefore, we provide (1) a descriptive overview of the application of the BMHSU in health services research in general and (2) a qualitative synthesis on the (un)suitability of the model in qualitative health services research. METHODS We searched five databases from March to April 2019, and in April 2020. For inclusion, each study had to focus on individuals ≥18 years of age and to cite the BMHSU, a modified version of the model, or the three core factors that constitute the model, regardless of study design, or publication type. We used MS Excel to perform descriptive statistics, and applied MAXQDA 2020 as part of a qualitative content analysis. RESULTS From a total of 6319 results, we identified 1879 publications dealing with the BMSHU. The main methodological approach was quantitative (89%). More than half of the studies are based on the BMHSU from 1995. 77 studies employed a qualitative design, the BMHSU was applied to justify the theoretical background (62%), structure the data collection (40%) and perform data coding (78%). Various publications highlight the usefulness of the BMHSU for qualitative data, while others criticise the model for several reasons (eg, its lack of cultural or psychosocial factors). CONCLUSIONS The application of different and older models of healthcare utilisation hinders comparative health services research. Future research should consider quantitative or qualitative study designs and account for the most current and comprehensive model of the BMHSU.
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Affiliation(s)
- Mareike Lederle
- Public Health and Health Education, Pädagogische Hochschule Freiburg, Freiburg im Breisgau, Germany
| | - Jana Tempes
- Public Health and Health Education, Pädagogische Hochschule Freiburg, Freiburg im Breisgau, Germany
| | - Eva M Bitzer
- Public Health and Health Education, Pädagogische Hochschule Freiburg, Freiburg im Breisgau, Germany
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Abstract
Medication non-adherence is one of the major problems in treating patients with depression. Non-adherence results in an increased risk of relapse and reduced quality of life. The objective of this review was to review and summarize studies that focused on the factors associated with antidepressant medication non-adherence in patients with depression. Literature searches were performed using PubMed/Medline and Google Scholar. The search was limited to articles published in the English language in peer-reviewed journals between January 2000 and December 2019. Studies that analyzed factors of non-compliance in patients with depressive disorders were included in the review. Patient-related factors such as forgetfulness, comorbidities, and misconceptions about the disease and medication, medication-related factors, polypharmacy, side effects, pill burden and cost, healthcare system-related factors, including physician-patient interactions, sociocultural factors such religious and cultural beliefs and stigma, and logistic factors were found to be the major factors associated with antidepressant non-adherence. Efforts should be made to increase patient adherence to antidepressants by strengthening physician-patient relationships, simplifying medication regimens, and rectifying myths and beliefs held by patients with scientific information and explanations.
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Affiliation(s)
- Nirmal Raj Marasine
- Department of Pharmacy, Karnali College of Health Science, Gaushala, Kathmandu, Nepal
| | - Sabina Sankhi
- Department of Pharmacy, Modern Technical College, Sanepa, Lalitpur, Nepal
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11
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Facer BD, Bingham B, Fleisch SB, Walker JN, Ahmad M, Osmundson EC. Radiation Therapy Adherence Among Patients Experiencing Homelessness. Int J Radiat Oncol Biol Phys 2021; 109:1019-1027. [PMID: 33127492 DOI: 10.1016/j.ijrobp.2020.10.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/20/2020] [Accepted: 10/23/2020] [Indexed: 11/18/2022]
Abstract
PURPOSE Radiation therapy is a valuable, yet time- and resource-intense therapy. Patients experiencing homelessness (PEH) face many barriers related to the timely receipt of radiation therapy. Owing to a paucity of data regarding cancer treatment and homelessness, clinicians have a limited evidence base when recommending therapy to PEH. This study was performed to evaluate adherence to radiation therapy treatment regimens in PEH with cancer. METHODS AND MATERIALS The study cohort was primarily derived from the Vanderbilt University Medical Center Homeless Health Services program. Patients in the Homeless Health Services program with radiation oncology visits were identified by query of the electronic medical record. Manual chart review was performed to gather standard treatment parameters and data describing missed appointments. A comparison group of patients not experiencing homelessness (non-PEH) was generated by aggregating appointment data for all other patients receiving similar treatments at Vanderbilt University Medical Center during multiple, consecutive years. RESULTS In the study, 3408 PEH were identified, of whom 48 underwent radiation oncology consultation. Thirty-two were prescribed at least 1 course of radiation therapy, for a total of 54 unique courses. Out of these courses, 34 (62.9%) were completed as prescribed without delay, 12 (22.2%) were completed with delay(s), and 8 (14.8%) were not fully completed. Although the PEH cohort had significantly higher rates of delayed and undelivered fractions, the proportion of delayed or incomplete courses was not significantly different from the comparison group of non-PEH, particularly for courses with 10 or fewer fractions. Reasons for missed appointments for PEH were variable. CONCLUSIONS This is the first publication describing adherence to radiation therapy in PEH. Our data suggest that PEH are as likely as non-PEH to complete a course of radiation therapy, albeit with more treatment interruptions. When treatment courses of >10 fractions are expected, PEH may benefit from more hypofractionated regimens, provided they have equivalent clinical efficacy to longer regimens. Documenting reasons for missed appointments will be essential to further understanding the needs of PEH. This study serves as a foundation for further analysis regarding homelessness and radiation therapy.
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Affiliation(s)
- Benjin D Facer
- Vanderbilt University School of Medicine, Nashville, Tennessee; University of Texas Rio Grande Valley, Edinburg, Texas.
| | - Brian Bingham
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sheryl B Fleisch
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jessica N Walker
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mahmoud Ahmad
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Evan C Osmundson
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
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12
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Increases in social support co-occur with decreases in depressive symptoms and substance use problems among adults in permanent supportive housing: an 18-month longitudinal study. BMC Psychol 2021; 9:6. [PMID: 33407857 PMCID: PMC7789599 DOI: 10.1186/s40359-020-00507-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 12/21/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Social support is a well-known protective factor against depressive symptoms and substance use problems, but very few studies have examined its protective effects among residents of permanent supportive housing (PSH), a housing program for people with a history of chronic homelessness. We utilized unconditional latent growth curve models (LGCMs) and parallel process growth models to describe univariate trajectories of social support, depressive symptoms, and substance use problems and to examine their longitudinal associations in a large sample of adults residing in PSH. METHODS Participants were 653 adult PSH residents in North Texas (56% female; 57% Black; mean age: 51 years) who participated in a monthly health coaching program from 2014 to 2017. Their health behaviors were assessed at baseline and tracked every six months at three follow-up visits. RESULTS Unconditional LGCMs indicated that over time, social support increased, whereas depressive symptoms and substance use problems decreased. However, their rates of change slowed over time. Further, in parallel process growth models, we found that at baseline, individuals with greater social support tended to have less severe depressive symptoms and substance use problems (coefficients: - 0.67, p < 0.01; - 0.52, p < 0.01, respectively). Individuals with a faster increase in social support tended to have steeper rates of reduction in both depressive symptoms (coefficient: - 0.99, p < 0.01) and substance use problems (coefficient: - 0.98, p < 0.01), respectively. CONCLUSIONS This study suggests that plausibly, increases in social support, though slowing over time, still positively impact depressive symptoms and substance use problems among PSH residents. Future PSH programs could emphasize social support as an early component as it may contribute to clients' overall health.
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13
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Gilmartin CE, Milman O, Leung L. Postpartum contraceptive planning of women with substance abuse disorders. Int J Clin Pharm 2020; 43:1006-1014. [PMID: 33236276 DOI: 10.1007/s11096-020-01209-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 11/19/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Women with substance abuse disorders have lower use of contraception. Unplanned pregnancies increase risk of fetal exposure to addictive and teratogenic substances. Postpartum inpatient periods for these women can be challenging times to facilitate contraception planning. OBJECTIVE To explore postnatal contraceptive planning practices, patient preferences for contraception, and supply challenges, and to identify how clinical pharmacists may best provide care in this context. SETTING A tertiary maternity referral hospital in metropolitan Victoria, Australia (January 2015-December 2018). METHOD A retrospective cohort study was conducted on postnatal women with substance abuse disorders. Patients were excluded if they had delivered at another health service, had inadequate documented evidence of a substance abuse disorder, or had incomplete or unavailable medical records. Records were reviewed for demographic data, admission details, and documented contraceptive planning. MAIN OUTCOME MEASURES Documented contraceptive planning, patient contraception preferences and identified supply challenges. RESULTS Ninety-three women were included. Seventy-one (76.3%) had psychiatric disorders or impairments, and 92 (98.9%) had identifiable follow-up challenges (eg. Homelessness). Nine (9.7%) self-discharged/absconded. Eighty-seven (93.5%) had documented postnatal contraception discussions. Sixty-two of 87 (71.3%) considered a medicine/device, three (3.4%) preferred condoms, 10 (11.5%) considered sterilisation, 2 (2.3%) preferred no contraception, and 16 (18.4%) undecided. Etonogestral 68 mg implants were most commonly prescribed (28 of 42; 66.7%). CONCLUSION Inpatient postpartum periods for this cohort were characterised by psycho-social complexities, inconsistent contraceptive planning documentation, and patients seemingly unprepared to consider contraception. This study highlights a need for an earlier decision-making process and pragmatic counselling with antenatal pharmacists.
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Affiliation(s)
- Christine E Gilmartin
- The Royal Women's Hospital Pharmacy Department, The Royal Women's Hospital, Parkville, Victoria, Australia.
| | - Oran Milman
- The Royal Women's Hospital Pharmacy Department, The Royal Women's Hospital, Parkville, Victoria, Australia.,Hawke's Bay Hospital, Hastings, New Zealand
| | - Laura Leung
- The Royal Women's Hospital Pharmacy Department, The Royal Women's Hospital, Parkville, Victoria, Australia
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14
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Pardhan A, Vu K, Gallo-Hershberg D, Forbes L, Gavura S, Kukreti V. Evolving Best Practice for Take-Home Cancer Drugs. JCO Oncol Pract 2020; 17:e526-e536. [PMID: 33079644 DOI: 10.1200/op.20.00448] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Take-home cancer drugs (THCDs) have become a standard treatment of many cancers. Robust guidelines have been developed for intravenous chemotherapy drugs, but few exist for THCDs with a focus on decentralized models. Hence, Ontario Health (Cancer Care Ontario) established the Oncology Pharmacy Task Force (OPTF) to develop consensus-based recommendations on best practices for THCDs to ensure that patients receive safe, consistent, high-quality care in the community once they leave the cancer center/practice with a prescription. METHODS The OPTF included 34 members with comprehensive representation. Guidance from leading authorities was extracted through literature review, thematically analyzed, and synthesized to develop 29 recommendations. The consensus process (> 70% agreement) included a three-step modified Delphi method followed by an extensive review process. RESULTS Sixteen recommendations were developed: training and education for providers (2), drug access (1), prescribing (4), patient and family/caregiver education (3), communication (1), dispensing (3), monitoring for patient adherence and adverse effects (1), and incident reporting (1). CONCLUSION Through a rigorous methodology, the OPTF derived a robust set of recommendations similar to the ASCO/Oncology Nursing Society and ASCO/National Community Oncology Dispensing Association guidelines, further validating and strengthening the applicability across multiple jurisdictions, including those with decentralized models. Unique aspects in a decentralized model include the need for two pharmacy professionals, with one doing cognitive verification of the script and the other dispensing the medication; moreover, they optimize interprofessional communication between community providers and the cancer center/practice health care team.
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Affiliation(s)
- Aliya Pardhan
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Kathy Vu
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Daniela Gallo-Hershberg
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Leta Forbes
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada.,Lakeridge Health, Oshawa, Ontario, Canada
| | - Scott Gavura
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Vishal Kukreti
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada.,Princess Margaret Cancer Centre, Toronto, Ontario, Canada
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15
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Holmes CT, Holmes KA, MacDonald A, Lonergan FR, Hunt JJ, Shaikh S, Cheeti R, D'Etienne JP, Zenarosa NR, Wang H. Dedicated homeless clinics reduce inappropriate emergency department utilization. J Am Coll Emerg Physicians Open 2020; 1:829-836. [PMID: 33145527 PMCID: PMC7593501 DOI: 10.1002/emp2.12054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 02/28/2020] [Accepted: 03/04/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The homeless patient population is known to have a high occurrence of inappropriate emergency department (ED) utilization. The study hospital initiated a dedicated homeless clinic targeting patients experiencing homelessness with a combination of special features. We aim to determine whether this mode of care can reduce inappropriate ED utilization among homeless patients. METHODS We conducted a retrospective observational study from July 1, 2017 to Dec 31, 2017. The study enrolled all homeless patients who visited any hospital regular clinic, dedicated homeless clinic, and ED at least once during the study period. ED homeless patients were divided into four groups (A: no clinic visits; B: those who only visited hospital regular clinic; C: those who only visited dedicated homeless clinic; and D: those who visited both hospital regular clinic and dedicated homeless clinic). The New York University algorithm was used to determine appropriate ED utilization. We compared inappropriate ED utilization among patients from these groups. Multivariate logistic regression was used to determine the risks of different clinical visits in association with inappropriate ED utilization. RESULTS A total of 16,323 clinic and 8511 ED visits occurred among 5022 unique homeless patients, in which 2450 unique patients were seen in hospital regular clinic, 784 patients in dedicated homeless clinic, 688 patients in both hospital regular clinic and dedicated homeless clinic, and 1110 patients with no clinic visits. Twenty-nine percent (230/784) of patients from dedicated homeless clinic utilized the ED, among which 21% (175/844) of their ED visits were considered inappropriate. In contrast, 40% of patients from hospital regular clinic utilized the ED, among which 29% were inappropriate (P < 0.001). The adjusted odds ratio (OR) was 0.61 (95% confidence interval [CI] = 0.50-0.74, P < 0.001) on dedicated homeless clinic predicting inappropriate ED visits in multivariate logistic regression. CONCLUSION Implementing a dedicated homeless clinic with these features can reduce ED inappropriate utilization among patients experiencing homelessness.
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Affiliation(s)
- Chad T. Holmes
- Department of Emergency MedicineJohn Peter Smith Health NetworkFort WorthTexas
- Integrative Emergency ServicesDallasTexas
| | - Katherine A. Holmes
- Department of Emergency MedicineJohn Peter Smith Health NetworkFort WorthTexas
- Integrative Emergency ServicesDallasTexas
| | - Andrew MacDonald
- Department of Emergency MedicineJohn Peter Smith Health NetworkFort WorthTexas
| | - Frank R. Lonergan
- Department of Family MedicineJohn Peter Smith Health NetworkFort WorthTexas
| | - Joel J. Hunt
- Department of Family MedicineJohn Peter Smith Health NetworkFort WorthTexas
| | - Sajid Shaikh
- Department of Information TechnologyJohn Peter Smith Health NetworkFort WorthTexas
| | - Radhika Cheeti
- Department of Information TechnologyJohn Peter Smith Health NetworkFort WorthTexas
| | - James P. D'Etienne
- Department of Emergency MedicineJohn Peter Smith Health NetworkFort WorthTexas
- Integrative Emergency ServicesDallasTexas
| | - Nestor R. Zenarosa
- Department of Emergency MedicineJohn Peter Smith Health NetworkFort WorthTexas
- Integrative Emergency ServicesDallasTexas
| | - Hao Wang
- Department of Emergency MedicineJohn Peter Smith Health NetworkFort WorthTexas
- Integrative Emergency ServicesDallasTexas
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16
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Dickins KA, Buchholz SW, Ingram D, Braun LT, Hamilton RJ, Earle M, Karnik NS. Supporting Primary Care Access and Use among Homeless Persons. SOCIAL WORK IN PUBLIC HEALTH 2020; 35:335-357. [PMID: 32865153 DOI: 10.1080/19371918.2020.1809589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
With the implementation of the Affordable Care Act (ACA), many homeless persons who previously lacked health insurance gained medical coverage. This paper describes the experiences of homeless persons in accessing and using primary care services, post-implementation of the ACA. Twenty-six semi-structured interviews were completed with homeless persons and primary care providers/staff. Via thematic analysis, themes were identified, categorized by: factors which influence primary care access and use patterns, and strategies to promote consistent primary care use. Maintaining insurance and leveraging systems-based strategies to support primary care access and use may address health disparities and promote health equity.
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Affiliation(s)
- Kirsten A Dickins
- Massachusetts General Hospital, Yvonne L. Munn Center for Nursing Research , Boston, Massachusetts, USA
| | | | - Diana Ingram
- Rush University College of Nursing , Chicago, Illinois, USA
| | - Lynne T Braun
- Rush University College of Nursing , Chicago, Illinois, USA
| | | | - Melinda Earle
- Rush University College of Nursing , Chicago, Illinois, USA
| | - Niranjan S Karnik
- Rush Medical College Department of Psychiatry, Rush University College of Nursing , Chicago, Illinois, USA
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17
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Shakarneh JK, Hallak HO, Awadallah HB, Al-Hamed DH, Khdour MR. Necessity and concerns about lipid-lowering medical treatments and risk factors for non-adherence: A cross-sectional study in Palestine. Int J Clin Pract 2020; 74:e13511. [PMID: 32279380 DOI: 10.1111/ijcp.13511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 03/17/2020] [Accepted: 04/06/2020] [Indexed: 12/11/2022] Open
Abstract
AIMS Strong evidence indicates that drugs reduce blood lipids and improve cardiovascular end-points, leading to their wide usage. However, the success of these drugs can be affected by poor patient's adherence to prescribed medication. This study aimed to evaluate medication adherence in patients with dyslipidaemia in association with patient beliefs about medicines. METHODS The study was conducted from January 2019 to July 2019 at the middle governmental primary healthcare clinics in Ramallah and Bethlehem cities, and used a cross-sectional design. Adherence was determined using the 4-item Morisky medication adherence scale, while beliefs were determined using the Beliefs about Medicines Questionnaire. RESULTS Of 220 patients, 185 agreed to participate in the study, resulting in a response rate of 84.1%. Of the participants, 106 (57.3%) were men, and almost half (88, 46.5%) were ≥56 years. Medication non-adherence was high (47.6%), but a majority (65.5%) reported believing their treatment to be necessary for their continued good health. Accordingly, the mean necessity score (17.3, SD 3.7) significantly outweighed (P < .001) the mean concerns score (14.0, SD 3.5). Multivariate regression demonstrated four variables to be significantly correlated with non-adherence: illiterate (OR = 2.52; CI: 0.9-4.3; P = .03), polypharmacy (OR = 3.18; CI: 1.9-5.7; P = .007), having comorbidity (OR = 3.10; CI: 2.2-4.6; P = .005) and having concerns about side effects (OR = 2.89; CI: 1.1-4.6, P = .04). CONCLUSION Non-adherence among patients taking lipid-lowering agents was high despite most holding positive beliefs regarding medication necessity. This may be due to concern also being high. Physicians should identify and target high-risk patients and individualise their treatment plans in order to achieve adequate control of dyslipidaemia.
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Affiliation(s)
| | | | | | - Dua'a H Al-Hamed
- Pharmacy Department Ramallah & Al-bireh Health Directorate, West Bank, Palestine
| | - Maher R Khdour
- Faculty of Pharmacy, Al-Quds University, Jerusalem, Palestine
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18
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Sulkowski M, Luetkemeyer AF, Wyles DL, Martorell C, Muir A, Weisberg I, Gordon SC, McLain R, Huhn G. Impact of a digital medicine programme on hepatitis C treatment adherence and efficacy in adults at high risk for non-adherence. Aliment Pharmacol Ther 2020; 51:1384-1396. [PMID: 32352586 DOI: 10.1111/apt.15707] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 01/20/2020] [Accepted: 03/12/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Direct-acting anti-virals (DAA) are highly effective for hepatitis C virus (HCV) treatment, but perceived risks of medication non-adherence may restrict access to care. Digital medicine programme (DMP) has improved adherence and outcomes for some conditions. AIMS To conduct a prospective, single-arm, open-label study across the United States to assess the impact of DMP on adherence and efficacy in adults with chronic HCV infection at high risk for non-adherence. METHODS Eligible participants were placed on the DMP to evaluate real-time adherence; primary outcome was sustained virological response (SVR) at ≥10 weeks post-treatment. RESULTS Between August 2017 and April 2019, 288 participants (Medicaid, 64.9%; psychiatric disorders, 61.1%; homeless, 9.4%) received DAAs for 8-12 weeks (sofosbuvir/velpatasvir or ledipasvir, 45%; glecaprevir/pibrentasvir, 55%). SVR was achieved in 99.1% of 218 participants who had HCV RNA assessed at ≥10 weeks post-treatment; of the 70 participants who did not have SVR assessed, 17 had SVR4 with HCV RNA assessed at a median (IQR; interquartile range) 5.6 weeks (4.1, 7.9) post-treatment; one completed treatment but did not have HCV RNA assessed, and 52 discontinued treatment early without assessment. Overall, the primary analysed participants (n = 218) actively used the DMP for median (range) 92.9% (12.5%, 100%) of their prescribed treatment time, and overall pill-taking adherence was 95.0% (57.1%, 100%). Participants reported the programme was useful and easy to use through satisfaction surveys. CONCLUSIONS HCV treatment with DMP was accepted by patients and clinicians and may support HCV treatment outcomes among patients at high risk for treatment non-adherence (Clinical trials.gov NCT03164902).
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19
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Affiliation(s)
- Katherine A Koh
- Boston Health Care for the Homeless Program, Boston, Massachusetts.,Department of Psychiatry, Massachusetts General Hospital, Boston
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20
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Pharmacist impact on health outcomes in a homeless population. J Am Pharm Assoc (2003) 2020; 60:485-490. [PMID: 31901441 DOI: 10.1016/j.japh.2019.11.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 11/06/2019] [Accepted: 11/12/2019] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The aim of this study was to analyze the effect of clinical pharmacy services on health outcomes and medication adherence concerning hypertension and diabetes in the homeless population. METHODS This was a retrospective quasi-experimental study conducted between January 1, 2015, and December 31, 2016. The primary outcomes included median blood pressure and median glycosylated hemoglobin (A1C) change from baseline. The secondary end points included adherence to hypertension and diabetes medication, in addition to the differences in the number of admissions to urgent care clinics, emergency departments, or hospitals pre- and postpharmacist clinic visit. RESULTS One-hundred ninety-eight homeless patients were seen by a pharmacist over the study time frame, and 116 of these patients were included. There was a decrease in systolic and diastolic blood pressure in the 6-months postpharmacist visit (139 mm Hg vs. 135 mm Hg, P = 0.413, and 85 mm Hg vs. 82 mm Hg, P = 0.197, respectively). The percentage of patients who met the blood pressure goals increased from 55% to 66% (P = 0.093). A statistically significant decrease in A1C was found (7.7% vs 7.2%, P = 0.038). The number of patients who met the A1C goal increased from 20% to 41% (P = 0.267) after pharmacist intervention. No medication class was associated with a median proportion of days covered of 80% or greater. However, differences were seen with biguanides (34% vs. 43%, P = 0.004), calcium channel blockers (44% vs. 59%, P < 0.001), and thiazides (28% vs. 39%, P = 0.039) pre- and postintervention. There was no difference in the number of visits to emergency departments or urgent care clinics, or hospitalizations. CONCLUSION Homeless patients with hypertension and type 2 diabetes who had at least 1 visit with a pharmacist showed some improved health outcomes. Statistically significant benefits were seen in diabetes management, but not for blood pressure control.
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Richler MJ, Yousaf S, Hwang SW, Dewhurst NF. Descriptive study of homeless patients' perceptions that affect medication adherence. Am J Health Syst Pharm 2019; 76:1288-1295. [PMID: 31418791 DOI: 10.1093/ajhp/zxz139] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Results of a study to elucidate perceptions, attitudes, and beliefs about prescribed medications held by hospitalized patients who are homeless are reported. METHODS A qualitative descriptive study involving semistructured interviews was conducted to gather information and characterize hospitalized homeless patients' views and attitudes regarding medication use, with a focus on medication nonadherence. Medication nonadherence has been shown to be a factor contributing to higher rates of emergency department visits, increased hospital lengths of stay, and increased healthcare costs in homeless populations. Interviews were conducted during patients' admissions to the internal medicine service of a tertiary care, inner-city hospital. Interviews were audio-recorded and transcribed. Data were analyzed using conventional qualitative content analysis to generate data-driven codes and themes. RESULTS Twelve interviews were conducted (median patient age, 48.5 years). Eight patients (66.7%) were living in a shelter, and 11 (91.7%) had a mental illness. Patients were prescribed a median of 4 medications at the time of hospital admission. Four themes were identified: (1) a new appreciation of medications was acquired during hospitalization, (2) medications were perceived as necessary for maintaining health, (3) there was an interest in receiving medication education, and (4) concerns were expressed regarding medication adverse effects. CONCLUSION In interviews conducted during hospital admission, homeless patients expressed positive perceptions about the necessity of their medications but also concerns about medication adverse effects. Interventions to improve adherence may be successful if directed toward addressing treatment-related concerns.
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Affiliation(s)
- Matthew J Richler
- St. Michael's Hospital, Toronto, Canada, and Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
| | | | - Stephen W Hwang
- St. Michael's Hospital, Toronto, Canada, and Department of Medicine, Division of General Internal Medicine, University of Toronto, Toronto, Canada
| | - Norman F Dewhurst
- St. Michael's Hospital, Toronto, Canada, and Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
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22
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Coe AB, Bostwick JR, Choe HM, Thompson AN. Provider perceptions of pharmacists providing mental health medication support in patient-centered medical homes. J Am Pharm Assoc (2003) 2019; 59:555-559. [PMID: 31010786 DOI: 10.1016/j.japh.2019.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 02/04/2019] [Accepted: 03/05/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To identify primary care providers' (PCPs') comfort level, potential barriers to management of patients with mental health disorders, and attitudes around clinical pharmacist-provided mental health medication-related support. METHODS A 16-item cross-sectional survey was completed by PCPs in 14 patient-centered medical homes (PCMHs) at 1 academic medical center. Items assessed include PCPs' perceptions of the proportion of patients with a mental health condition, access to psychiatry services, confidence in mental health condition management, clinical pharmacist-provided mental health medication support, and demographics. Checklist, Likert-type-scale agreement statements, and an open-ended question to assess barriers to managing mental health medications were included. Descriptive statistics and qualitative content analysis were used. RESULTS Respondents (n = 85) included attending physicians (67.1%), resident physicians (24.7%), and advanced practice providers (8.2%). The average number of years in practice was 11 (SD 8.6). The majority perceived that 26% to 50% of their patients had a psychiatric illness (57.7%), referred < 10% of their patients (67.1%) to psychiatry services, and disagreed that access to psychiatric services was acceptably timely (87.0%). Participants felt confident diagnosing a patient with depression (97.6%) and starting antidepressants (94.1%) compared with antipsychotics (11.7%) or mood stabilizers (7.1%). Participants agreed that having the clinical pharmacist in clinic to provide support regarding psychiatric medications would increase their comfort level; increase in comfort level by provider type was not different (P = 0.20). Emerging barriers were lack of knowledge or training, low comfort in diagnosing severe psychiatric conditions, and access to psychiatry services. CONCLUSION Outside of the diagnosis and treatment of depression, PCPs indicate a lack of comfort in treating PCMH patients with mental health disorders. Pharmacists can play a key role by providing mental health medication management support to improve access and address PCMH patients' mental health needs.
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Fernandez-Lazaro CI, Adams DP, Fernandez-Lazaro D, Garcia-González JM, Caballero-Garcia A, Miron-Canelo JA. Medication adherence and barriers among low-income, uninsured patients with multiple chronic conditions. Res Social Adm Pharm 2018; 15:744-753. [PMID: 30241872 DOI: 10.1016/j.sapharm.2018.09.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 08/30/2018] [Accepted: 09/13/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Poor adherence to long-term therapies is a public health concern that affects all populations. Little is known about the context of adherence in chronic diseases for the uninsured population in the United States. OBJECTIVE To evaluate medication adherence and barriers among low-income, uninsured adults recently initiating new therapy for a chronic disease. METHODS A cross-sectional study in two Community Health Centers located in Chatham County, Georgia, was performed between September and December 2015. Patients, randomly selected for inclusion in the study, were eligible if they had been prescribed medication for 2 or more chronic conditions and had recently started a new medication regimen. The Morisky-Green-Levine questionnaire was used to assess adherence. Potential barriers were analyzed using the Multidimensional Model proposed by the World Health Organization-social and economic, healthcare team and system-related, condition-related, therapy-related, and patient-related factors. Multivariate logistic regression models were used to analyze factors associated with non-adherence. RESULTS A total of 150 participants were interviewed at 6 months after treatment initiation. Non-adherence was reported by 52% of the participants. Higher adjusted odds of non-adherence were observed in participants who did not receive information about their medications (adjusted odds ratio [AOR] = 2.40, 95% confidence interval [CI] = 1.01-5.74), did not regularly visit a primary health-care provider (AOR = 2.74, 95% CI = 1.09-6.88), and had changes in their treatment (AOR = 3.75, 95% CI = 1.62-8.70). Alternatively, adjusted odds of non-adherence were lower for patients who reported using pillboxes (AOR = 0.31, 95% CI = 0.10-0.95), having help from a caregiver (AOR = 0.15, 95% CI = 0.04-0.60), and integrating medication dosing into daily routines (AOR = 0.18, 95% CI = 0.06-0.59). CONCLUSIONS Medication non-adherence was common among low-income, uninsured patients initiating therapy for chronic conditions. Several modifiable barriers highlight opportunities to address medication non-adherence through multidisciplinary interventions.
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Affiliation(s)
- Cesar I Fernandez-Lazaro
- Department of Biomedical and Diagnostic Sciences, School of Medicine, University of Salamanca, C/ Alfonso X El Sabio s/n., 37007, Salamanca, Spain; Department of Health Sciences, Armstrong State University, 11935 Abercorn St, Savannah, GA, 31419, USA.
| | - David P Adams
- Department of General Studies, Point University-Savannah Campus, 55 Al Henderson Blvd, Savannah, GA, 31419, USA
| | - Diego Fernandez-Lazaro
- Department of Biochemistry and Physiology, School of Physical Therapy, University of Valladolid, Campus Duques de Soria, 42003, Soria, Spain.
| | - Juan M Garcia-González
- Department of Sociology, Pablo de Olavide University, Ctra. de Utrera, 1, 41013, Sevilla, Spain.
| | - Alberto Caballero-Garcia
- Department of Anatomy, School of Physiotherapy, University of Valladolid, Campus Duques de Soria, 42004, Soria, Spain.
| | - Jose A Miron-Canelo
- Department of Biomedical and Diagnostic Sciences, School of Medicine, University of Salamanca, C/ Alfonso X El Sabio s/n., 37007, Salamanca, Spain.
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Rezansoff SN, Moniruzzaman A, Fazel S, McCandless L, Procyshyn R, Somers JM. Housing First Improves Adherence to Antipsychotic Medication Among Formerly Homeless Adults With Schizophrenia: Results of a Randomized Controlled Trial. Schizophr Bull 2018; 43:852-861. [PMID: 27665002 PMCID: PMC5274537 DOI: 10.1093/schbul/sbw136] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Adherence to antipsychotic medication is a significant challenge among homeless patients. No experimental trials have investigated the impact of Housing First on adherence among patients with schizophrenia. We investigated whether Housing First in congregate and scattered-site configurations resulted in superior adherence compared to usual care. Adult participants (n = 165) met criteria for homelessness, schizophrenia, and initiation of antipsychotic pharmacotherapy prior to recruitment to an unblinded, 3-arm randomized controlled trial in Vancouver, Canada. Randomization arms were: congregate Housing First (CHF) with on-site supports (including physician and pharmacy services); scattered-site Housing First (SHF) with Assertive Community Treatment; or treatment as usual (TAU) consisting of existing services. Participants were followed for an average of 2.6 years. Adherence to antipsychotic medication was measured using the medication possession ratio (MPR), and 1-way ANOVA was used to compare outcomes between the 3 conditions. Data were drawn from comprehensive pharmacy records. Prior to randomization, mean MPR among participants was very low (0.44–0.48). Mean MPR in the follow-up period was significantly different between study arms (P < .001) and approached the guideline threshold of 0.80 in SHF. Compared to TAU, antipsychotic adherence was significantly higher in SHF but not in CHF. The results demonstrate that further implementation of SHF is indicated among homeless people with schizophrenia, and that urgent action is needed to address very low levels of antipsychotic adherence in this population (trial registration: ISRCTN57595077).
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Affiliation(s)
- Stefanie N Rezansoff
- Somers Research Group, Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Akm Moniruzzaman
- Somers Research Group, Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Seena Fazel
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | | | - Ric Procyshyn
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Julian M Somers
- Somers Research Group, Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
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25
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Salhi BA, White MH, Pitts SR, Wright DW. Homelessness and Emergency Medicine: A Review of the Literature. Acad Emerg Med 2018; 25:577-593. [PMID: 29223132 DOI: 10.1111/acem.13358] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 11/24/2017] [Accepted: 12/04/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVES We aimed to synthesize the available evidence on the demographics, prevalence, clinical characteristics, and evidence-based management of homeless persons in the emergency department (ED). Where appropriate, we highlight knowledge gaps and suggest directions for future research. METHODS We conducted a systematic literature search following databases: PubMed, Ovid, and Google Scholar for articles published between January 1, 1990, and December 31, 2016. We supplemented this search by cross-referencing bibliographies of the retrieved publications. Peer-reviewed studies written in English and conducted in the United States that examined homelessness within the ED setting were included. We used a qualitative approach to synthesize the existing literature. RESULTS Twenty-eight studies were identified that met the inclusion criteria. Based on our study objectives and the available literature, we grouped articles examining homeless populations in the ED into four broad categories: 1) prevalence and sociodemographic characteristics of homeless ED visits, 2) ED utilization by homeless adults, 3) clinical characteristics of homeless ED visits, and 4) medical education and evidence-based management of homeless ED patients. CONCLUSION Homelessness may be underrecognized in the ED setting. Homeless ED patients have distinct care needs and patterns of ED utilization that are unmet by the current disease-oriented and episodic models of emergency medicine. More research is needed to determine the prevalence and characteristics of homelessness in the ED and to develop evidence-based treatment strategies in caring for this vulnerable population.
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Affiliation(s)
- Bisan A. Salhi
- Department of Emergency Medicine Emory University Atlanta GA
- Department of Anthropology Emory University Atlanta GA
| | | | | | - David W. Wright
- Department of Emergency Medicine Emory University Atlanta GA
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26
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Maestri TJ, Mican LM, Rozea H, Barner JC. Do Long-Acting Injectable Antipsychotics Prevent or Delay Hospital Readmission? PSYCHOPHARMACOLOGY BULLETIN 2018; 48:8-15. [PMID: 29713100 PMCID: PMC5875369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Long-acting injectable (LAI) antipsychotics were developed as a way to decrease pill burden and simplify medication regimens by allowing less frequent administration to assist with medication adherence. METHODS The purpose of this study was to determine whether LAI antipsychotics prevent or delay hospital readmission in patients with a known history of medication non-adherence. The study is a retrospective evaluation of 240 men and women 18-65 years of age diagnosed with bipolar disorder, schizophrenia, or schizoaffective disorder discharged from an inpatient state hospital over a 2 year period of time on a LAI antipsychotic (fluphenazine LAI, haloperidol LAI, risperidone LAI or paliperidone LAI) or oral antipsychotic. Patients on LAIs were matched to patients on an equivalent oral dose, psychiatric diagnosis, number of prior hospital admissions, and length of stay. RESULTS Those who received a LAI (N = 120) had a significantly longer survival time (mean 278.0 days) without readmission compared to those who did not (N = 120; mean 243.6 days). There was no statistically significant difference in the frequency of one-year readmission between those who did receive a LAI (43.1%) and those who did not (56.9%). Those who received a LAI with administration frequency of a month or longer had a significantly longer survival time without readmission (mean 307.9 days) when compared to those with a shorter administration frequency (mean 245.0 days). CONCLUSION This study revealed the use of LAI antipsychotics in those with a history of medication non-adherence, particularly those with longer administration frequency, have potentially promising outcomes.
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Affiliation(s)
- Thomas J Maestri
- Maestri, PharmD, BCPP, Clinical Assistant Professor, Xavier University of Louisiana College of Pharmacy, New Orleans LA. Mican, PharmD, BCPP, Assistant Director of Pharmacy, Austin State Hospital, Clinical Assistant Professor, UT-Austin College of Pharmacy, Austin TX. Rozea, PharmD, PGY-1 Pharmacy Practice Resident, Michael E. DeBakey VA Medical Center, Houston TX. Barner, PhD, Professor, UT-Austin College of Pharmacy, Austin TX
| | - Lisa M Mican
- Maestri, PharmD, BCPP, Clinical Assistant Professor, Xavier University of Louisiana College of Pharmacy, New Orleans LA. Mican, PharmD, BCPP, Assistant Director of Pharmacy, Austin State Hospital, Clinical Assistant Professor, UT-Austin College of Pharmacy, Austin TX. Rozea, PharmD, PGY-1 Pharmacy Practice Resident, Michael E. DeBakey VA Medical Center, Houston TX. Barner, PhD, Professor, UT-Austin College of Pharmacy, Austin TX
| | - Heather Rozea
- Maestri, PharmD, BCPP, Clinical Assistant Professor, Xavier University of Louisiana College of Pharmacy, New Orleans LA. Mican, PharmD, BCPP, Assistant Director of Pharmacy, Austin State Hospital, Clinical Assistant Professor, UT-Austin College of Pharmacy, Austin TX. Rozea, PharmD, PGY-1 Pharmacy Practice Resident, Michael E. DeBakey VA Medical Center, Houston TX. Barner, PhD, Professor, UT-Austin College of Pharmacy, Austin TX
| | - Jamie C Barner
- Maestri, PharmD, BCPP, Clinical Assistant Professor, Xavier University of Louisiana College of Pharmacy, New Orleans LA. Mican, PharmD, BCPP, Assistant Director of Pharmacy, Austin State Hospital, Clinical Assistant Professor, UT-Austin College of Pharmacy, Austin TX. Rozea, PharmD, PGY-1 Pharmacy Practice Resident, Michael E. DeBakey VA Medical Center, Houston TX. Barner, PhD, Professor, UT-Austin College of Pharmacy, Austin TX
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27
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Roche M, Duffield C, Smith J, Kelly D, Cook R, Bichel-Findlay J, Saunders C, Carter D. Nurse-led primary health care for homeless men: a multimethods descriptive study. Int Nurs Rev 2017; 65:392-399. [DOI: 10.1111/inr.12419] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- M.A. Roche
- Mental Health Drug and Alcohol Nursing; Northern Sydney Local Health District & Australian Catholic University; Sydney NSW Australia
- Faculty of Health; University of Technology Sydney; Sydney NSW Australia
| | - C. Duffield
- Nursing & Health Services Management; University of Technology Sydney; Sydney NSW Australia
- Nursing & Health Services Management; Edith Cowan University; Western Australia
| | - J. Smith
- Primary Health Clinic; Matthew Talbot Hostel; St Vincent de Paul Society New South Wales; Woolloomooloo NSW Australia
| | - D. Kelly
- Support Services; St Vincent de Paul Society New South Wales; Australia
| | - R. Cook
- Centre for Health Services Management; University of Technology Sydney; Sydney NSW Australia
| | - J. Bichel-Findlay
- Digital Health and Innovation; Centre for Health Services Management; Faculty of Health; University of Technology Sydney; Sydney NSW Australia
| | - C. Saunders
- Centre for Health Services Management; Faculty of Health; University of Technology Sydney; Sydney NSW Australia
| | - D.J. Carter
- Faculty of Law; University of Technology Sydney; Sydney NSW Australia
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28
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Leickly E, Skalisky J, Oluwoye O, McPherson SM, Srebnik D, Roll JM, Ries RK, McDonell MG. Homelessness predicts attrition but not alcohol abstinence in outpatients experiencing co-occurring alcohol dependence and serious mental illness. Subst Abus 2017; 39:271-274. [PMID: 29161228 DOI: 10.1080/08897077.2017.1391926] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Adults experiencing homelessness and serious mental illnesses (SMI) are at an increased risk of poor mental health and treatment outcomes compared with stably housed adults with SMI. The additional issue of alcohol misuse further complicates the difficulties of those living with homelessness and SMI. In this secondary data analysis, the authors investigated the impact of homelessness on attrition and alcohol use in a contingency management (CM) intervention that rewarded alcohol abstinence in outpatients with SMI. METHODS The associations between housing status and attrition and alcohol abstinence during treatment, as assessed by ethyl glucuronide (EtG) urine tests, were evaluated in 79 adults diagnosed with alcohol dependence and SMI. RESULTS Thirty-nine percent (n = 31) of participants reported being homeless at baseline. Individuals who were homeless were more likely to drop out of CM (n = 10, 62.5%) than those who were housed (n = 4, 16.7%), χ2(1) = 8.86, P < .05. Homelessness was not associated with attrition in the noncontingent control group. Accounting for treatment group and prerandomization EtG levels, neither the effect of housing status nor the interaction of housing status and group were associated with EtG-assessed alcohol abstinence during treatment. CONCLUSIONS Individuals experiencing homelessness and co-occurring alcohol dependence and SMI receiving CM had higher rates of attrition, relative to those who were housed. Homelessness was not associated with differences in biologically assessed alcohol abstinence.
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Affiliation(s)
- Emily Leickly
- a Initiative for Research and Education to Advance Community Health, Washington State University , Spokane , Washington , USA.,b Elson S. Floyd College of Medicine, Washington State University , Spokane , Washington , USA.,c Program of Excellence in Addiction Research, Washington State University , Spokane , Washington , USA.,d Department of Psychology , Portland State University , Portland , Oregon , USA
| | - Jordan Skalisky
- a Initiative for Research and Education to Advance Community Health, Washington State University , Spokane , Washington , USA.,b Elson S. Floyd College of Medicine, Washington State University , Spokane , Washington , USA.,c Program of Excellence in Addiction Research, Washington State University , Spokane , Washington , USA
| | - Oladunni Oluwoye
- a Initiative for Research and Education to Advance Community Health, Washington State University , Spokane , Washington , USA.,b Elson S. Floyd College of Medicine, Washington State University , Spokane , Washington , USA.,c Program of Excellence in Addiction Research, Washington State University , Spokane , Washington , USA
| | - Sterling M McPherson
- b Elson S. Floyd College of Medicine, Washington State University , Spokane , Washington , USA.,c Program of Excellence in Addiction Research, Washington State University , Spokane , Washington , USA.,e Providence Medical Research Center, Providence Health Care , Spokane , Washington, USA
| | - Debra Srebnik
- f Department of Psychiatry and Behavioral Sciences , University of Washington School of Medicine , Seattle , Washington, USA
| | - John M Roll
- b Elson S. Floyd College of Medicine, Washington State University , Spokane , Washington , USA.,c Program of Excellence in Addiction Research, Washington State University , Spokane , Washington , USA
| | - Richard K Ries
- b Elson S. Floyd College of Medicine, Washington State University , Spokane , Washington , USA.,f Department of Psychiatry and Behavioral Sciences , University of Washington School of Medicine , Seattle , Washington, USA
| | - Michael G McDonell
- a Initiative for Research and Education to Advance Community Health, Washington State University , Spokane , Washington , USA.,b Elson S. Floyd College of Medicine, Washington State University , Spokane , Washington , USA.,c Program of Excellence in Addiction Research, Washington State University , Spokane , Washington , USA
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Hanlon P, Yeoman L, Esiovwa R, Gibson L, Williamson AE, Mair FS, Lowrie R. Interventions by healthcare professionals to improve management of physical long-term conditions in adults who are homeless: a systematic review protocol. BMJ Open 2017; 7:e016756. [PMID: 28827259 PMCID: PMC5629632 DOI: 10.1136/bmjopen-2017-016756] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION People experiencing homelessness are at increased risk of, and have poorer outcomes from, a range of physical long-term conditions (LTCs). It is increasingly recognised that interventions targeting people who are homeless should be tailored to the specific needs of this population. This systematic review aims to identify, describe and appraise trials of interventions that aim to manage physical LTCs in homeless adults and are delivered by healthcare professionals. METHODS AND ANALYSIS Seven electronic databases (Medline, EMBASE, Cochrane Central Register of Controlled Trials, Assia, Scopus, PsycINFO and CINAHL) will be searched from 1960 (or inception) to October 2016 and supplemented by forward citation searching, handsearching of reference lists and searching grey literature. Two reviewers will independently review titles, abstract and full-texts using DistillerSR software. Inclusion criteria include (1) homeless adults with any physical LTC, (2) interventions delivered by a healthcare professional (any professional trained to provide any form of healthcare, but excluding social workers and professionals without health-related training), (3) comparison with usual care or an alternative intervention, (4) report outcomes such as healthcare usage, physical and psychological health or well-being or cost-effectiveness, (5) randomised controlled trials, non-randomised controlled trials, controlled before-after studies. Quality will be assessed using the Cochrane EPOC Risk of Bias Tool. A meta-analysis will be performed if sufficient data are identified; however, we anticipate a narrative synthesis will be performed. ETHICS AND DISSEMINATION This review will synthesise existing evidence for interventions delivered by healthcare professionals to manage physical LTCs in adults who are homeless. The findings will inform the development of future interventions and research aiming to improve the management of LTCs for people experiencing homelessness. Ethical approval will not be required for this systematic review as it does not contain individual patient data. We will disseminate the results of this systematic review via conference presentations, healthcare professional networks, social media and peer-reviewed publication. TRIAL REGISTRATION NUMBER PROSPERO registration number: CRD42016046183.
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Affiliation(s)
- Peter Hanlon
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glassgow, UK
| | - Lynsey Yeoman
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glassgow, UK
| | - Regina Esiovwa
- Pharmacy Prescribing and Support Unit, West Glasgow Ambulatory Care Centre, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Lauren Gibson
- Pharmacy Prescribing and Support Unit, West Glasgow Ambulatory Care Centre, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Andrea E Williamson
- General Practice and Primary Care, School of Medicine, Dentistry and Nursing, University of Glasgow, Glassgow, UK
| | - Frances S Mair
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glassgow, UK
| | - Richard Lowrie
- Pharmacy Prescribing and Support Unit, West Glasgow Ambulatory Care Centre, NHS Greater Glasgow and Clyde, Glasgow, UK
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Alhusen JL, Norris-Shortle C, Cosgrove K, Marks L. "I'M OPENING MY ARMS RATHER THAN PUSHING AWAY:" PERCEIVED BENEFITS OF A MINDFULNESS-BASED INTERVENTION AMONG HOMELESS WOMEN AND YOUNG CHILDREN. Infant Ment Health J 2017; 38:434-442. [PMID: 28464306 DOI: 10.1002/imhj.21641] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Family homelessness is associated with adverse outcomes in mothers and their young children. Evidence-based programs are needed to support the socioemotional needs of these families. The purpose of this qualitative study was to explore the perceived benefits of participating in a mindfulness program in mother-child dyads receiving services at a therapeutic nursery serving homeless children under the age of 3 years. A convenience sample of 17 predominantly African American mothers participated in in-depth qualitative interviews. Four themes were derived from the data regarding the perceived benefits of the mindfulness program: "me" time, maternal self-regulation, dyadic connectedness, and child well-being. Results demonstrate the perceived benefits of mindfulness on the parent-child relationship and have important implications for families at an increased risk of adverse outcomes. Because homelessness and residential instability confer considerable risk for young children, interventions to support effective parenting are critical.
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31
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Moczygemba LR, Cox LS, Marks SA, Robinson MA, Goode JVR, Jafari N. Homeless patients' perceptions about using cell phones to manage medications and attend appointments. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2016; 25:220-230. [PMID: 27896909 DOI: 10.1111/ijpp.12321] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 09/23/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The objectives of this study were to (1) describe homeless persons' access and use of cell phones and their perceptions about using cell phone alerts to help manage medications and attend health care appointments and (2) identify demographic characteristics, medication use and appointment history and perceptions associated with interest in receiving cell phone alerts to manage medications and appointments. METHODS A cross-sectional survey was conducted in 2013 at a homeless clinic in Virginia. The questionnaire comprised items about cell phone usage, ownership and functions such as text messaging. Participants reported medication use and appointment history, perceptions about cell phone alerts and interest in receiving alerts to manage medications and appointments. Descriptive statistics for all variables are reported. Logistic regression was used to examine predictors of interest in using a cell phone to manage medications and appointments. KEY FINDINGS A total of 290 participants completed the survey; 89% had a cell phone. Seventy-seven percent were interested in appointment reminders, whereas 66%, 60% and 54% were interested in refill reminders, medication taking reminders and medication information messages respectively. Those who believed reminders were helpful were more likely to be interested in medication taking, refill and appointment reminder messages compared to those who did not believe reminders were helpful. A history of running out of medicine and forgetting appointments were predictors of interest in refill and appointment reminders. CONCLUSIONS Mobile technology is a feasible method for communicating medication and appointment information to those experiencing or at risk for homelessness.
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Affiliation(s)
- Leticia R Moczygemba
- Health Outcomes and Pharmacy Practice Division, The University of Texas College of Pharmacy, Austin, TX, USA
| | - Lauren S Cox
- Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University, Richmond, VA, USA
| | - Samantha A Marks
- Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University, Richmond, VA, USA
| | - Margaret A Robinson
- Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University, Richmond, VA, USA
| | - Jean-Venable R Goode
- Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University, Richmond, VA, USA
| | - Nellie Jafari
- Allegheny General Hospital, Health-System Pharmacy Administration Resident, Pittsburgh, PA, USA
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32
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Global implementation of PrEP as part of combination HIV prevention - Unsolved challenges. J Int AIDS Soc 2016. [DOI: 10.7448/ias.19.7.21479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Sevelius JM, Deutsch MB, Grant R. The future of PrEP among transgender women: the critical role of gender affirmation in research and clinical practices. J Int AIDS Soc 2016; 19:21105. [PMID: 27760683 PMCID: PMC5071750 DOI: 10.7448/ias.19.7.21105] [Citation(s) in RCA: 113] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Revised: 06/28/2016] [Accepted: 07/12/2016] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Globally, transgender ("trans") women are one of the key populations most disproportionately impacted by HIV. Pre-exposure prophylaxis (PrEP) is the newest and most promising biomedical HIV prevention intervention to date. This paper reviews relevant literature to describe the current state of the science and describes the potential role of PrEP among trans women, including a discussion of unique considerations for maximizing the impact of PrEP for this vulnerable population. METHODS Available information, including but not limited to existing scientific literature, about trans women and PrEP was reviewed and critiqued based on author expertise, including PrEP clinical trials and rollout. RESULTS To date, PrEP demonstration projects and clinical trials have largely excluded trans women, or have not included them in a meaningful way. Data collection strategies that fail to identify trans women in clinical trials and research further limit the ability to draw conclusions about trans women's unique needs and devise strategies to meet them. Gender-affirming providers and clinic environments are essential components of any sexual health programme that aims to serve trans women, as they will largely avoid settings that may result in stigmatizing encounters and threats to their identities. While there is currently no evidence to suggest drug-drug interactions between PrEP and commonly used feminizing hormone regimens, community concerns about potential interactions may limit interest in and uptake of PrEP among trans women. CONCLUSIONS In scaling up PrEP for trans women, it is essential to engage trans communities, utilize trans-inclusive research and marketing strategies and identify and/or train healthcare providers to provide gender-affirming healthcare to trans women, including transition-related care such as hormone provision. PrEP implementation guidelines must consider and address trans women's unique barriers and facilitators to uptake and adherence.
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Affiliation(s)
- Jae M Sevelius
- Center of Excellence for Transgender Health, University of California, San Francisco, San Francisco, CA, USA
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA;
| | - Madeline B Deutsch
- Center of Excellence for Transgender Health, University of California, San Francisco, San Francisco, CA, USA
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Robert Grant
- Gladstone Institute, University of California, San Francisco, San Francisco, CA, USA
- San Francisco AIDS Foundation, San Francisco, CA, USA
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34
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Zemmour K, Tinland A, Boucekine M, Girard V, Loubière S, Resseguier N, Fond G, Auquier P, Boyer L. Validation of the Medication Adherence Rating Scale in homeless patients with schizophrenia: Results from the French Housing First experience. Sci Rep 2016; 6:31598. [PMID: 27534796 PMCID: PMC4989491 DOI: 10.1038/srep31598] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 07/26/2016] [Indexed: 01/08/2023] Open
Abstract
The Medication Adherence Rating Scale (MARS) is one of the most widely used measurements of adherence in schizophrenia (SZ), but there is no available data regarding its psychometric properties in homeless SZ patients (HSZ). The aim of this study was therefore to assess the psychometric properties of the MARS in a large multicenter sample of HSZ subjects. This multi-centre prospective study was conducted in the following 4 French cities: Lille, Marseille, Paris and Toulouse. Three hundred and fifty-three patients were included. The 3-factor structure of the MARS was confirmed using confirmatory factor analysis: RMSEA = 0.045, CFI = 0.98, TLI = 0.97 and WRMR = 0.76. The unidimensionality of each factor was supported by the satisfactory INFIT statistics. Item internal consistencies were all higher than 0.20 and the Kuder–Richardson were higher than to 0.6, except for factor 2, which was closed to 0.5. Significant associations with symptoms, functioning and quality of life showed satisfactory external validity. The acceptability was satisfactory with missing data lower than 5% for each dimension. The MARS is a short self-administered instrument with acceptable psychometric properties in homeless SZ patients that yields interesting information about medication adherence.
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Affiliation(s)
- K Zemmour
- Aix-Marseille Univ., EA 3279 Research Unit, 13385 Marseille, France.,Department of Psychiatry, Sainte-Marguerite University Hospital, Marseille, France
| | - A Tinland
- Aix-Marseille Univ., EA 3279 Research Unit, 13385 Marseille, France.,Department of Psychiatry, Sainte-Marguerite University Hospital, Marseille, France
| | - M Boucekine
- Aix-Marseille Univ., EA 3279 Research Unit, 13385 Marseille, France
| | - V Girard
- Aix-Marseille Univ., EA 3279 Research Unit, 13385 Marseille, France.,Department of Psychiatry, Sainte-Marguerite University Hospital, Marseille, France
| | - S Loubière
- Aix-Marseille Univ., EA 3279 Research Unit, 13385 Marseille, France
| | - N Resseguier
- Aix-Marseille Univ., EA 3279 Research Unit, 13385 Marseille, France
| | - G Fond
- Université Paris-Est Créteil, Pôle de psychiatrie des hôpitaux universitaires H Mondor, INSERM U955, Eq Psychiatrie Génétique, Fondation FondaMental Fondation de coopération scientifique en santé mentale, Pole de Psychiatrie, Hôpital A. Chenevier, 40 rue de Mesly, Créteil, F-94010, France
| | - P Auquier
- Aix-Marseille Univ., EA 3279 Research Unit, 13385 Marseille, France.,Department of Public Health, University Hospital, Marseille, France
| | - L Boyer
- Aix-Marseille Univ., EA 3279 Research Unit, 13385 Marseille, France.,Department of Public Health, University Hospital, Marseille, France
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Loh J, Kennedy MC, Wood E, Kerr T, Marshall B, Parashar S, Montaner J, Milloy MJ. Longer duration of homelessness is associated with a lower likelihood of non-detectable plasma HIV-1 RNA viral load among people who use illicit drugs in a Canadian setting. AIDS Care 2016; 28:1448-54. [PMID: 27248328 DOI: 10.1080/09540121.2016.1189498] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Homelessness is common among people who use drugs (PWUD) and, for those living with HIV/AIDS, an important contributor to sub-optimal HIV treatment outcomes. This study aims to investigate the relationship between the duration of homelessness and the likelihood of plasma HIV-1 RNA viral load (VL) non-detectability among a cohort of HIV-positive PWUD. We used data from the ACCESS study, a long-running prospective cohort study of HIV-positive PWUD linked to comprehensive HIV clinical records including systematic plasma HIV-1 RNA VL monitoring. We estimated the longitudinal relationship between the duration of homelessness and the likelihood of exhibiting a non-detectable VL (i.e., <500 copies/mL plasma) using generalized linear mixed-effects modelling. Between May 1996 and June 2014, 922 highly active antiretroviral therapy-exposed participants were recruited and contributed 8188 observations. Of these, 4800 (59%) were characterized by non-detectable VL. Participants reported they were homeless in 910 (11%) interviews (median: six months, interquartile range: 6-12 months). A longer duration of homelessness was associated with lower odds of VL non-detectability (adjusted odds ratio = 0.71 per six-month period of homelessness, 95% confidence interval: 0.60-0.83) after adjustment for age, ancestry, drug use patterns, engagement in addiction treatment, and other potential confounders. Longer durations of episodes of homelessness in this cohort of HIV-positive illicit drug users were associated with a lower likelihood of plasma VL non-detectability. Our findings suggest that interventions that seek to promptly house homeless individuals, such as Housing First approaches, might assist in maximizing the clinical and public health benefits of antiretroviral therapy among people living with HIV/AIDS.
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Affiliation(s)
- Jane Loh
- a British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver , Canada
| | - Mary Clare Kennedy
- a British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver , Canada
| | - Evan Wood
- a British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver , Canada.,b Division of AIDS, Department of Medicine , University of British Columbia , Vancouver , Canada
| | - Thomas Kerr
- a British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver , Canada.,b Division of AIDS, Department of Medicine , University of British Columbia , Vancouver , Canada
| | - Brandon Marshall
- a British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver , Canada
| | - Surita Parashar
- a British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver , Canada
| | - Julio Montaner
- a British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver , Canada.,b Division of AIDS, Department of Medicine , University of British Columbia , Vancouver , Canada
| | - M-J Milloy
- a British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver , Canada.,b Division of AIDS, Department of Medicine , University of British Columbia , Vancouver , Canada
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Fazel S, Geddes JR, Kushel M. The health of homeless people in high-income countries: descriptive epidemiology, health consequences, and clinical and policy recommendations. Lancet 2014; 384:1529-40. [PMID: 25390578 PMCID: PMC4520328 DOI: 10.1016/s0140-6736(14)61132-6] [Citation(s) in RCA: 857] [Impact Index Per Article: 85.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
In the European Union, more than 400,000 individuals are homeless on any one night and more than 600,000 are homeless in the USA. The causes of homelessness are an interaction between individual and structural factors. Individual factors include poverty, family problems, and mental health and substance misuse problems. The availability of low-cost housing is thought to be the most important structural determinant for homelessness. Homeless people have higher rates of premature mortality than the rest of the population, especially from suicide and unintentional injuries, and an increased prevalence of a range of infectious diseases, mental disorders, and substance misuse. High rates of non-communicable diseases have also been described with evidence of accelerated ageing. Although engagement with health services and adherence to treatments is often compromised, homeless people typically attend the emergency department more often than non-homeless people. We discuss several recommendations to improve the surveillance of morbidity and mortality in homeless people. Programmes focused on high-risk groups, such as individuals leaving prisons, psychiatric hospitals, and the child welfare system, and the introduction of national and state-wide plans that target homeless people are likely to improve outcomes.
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Affiliation(s)
- Seena Fazel
- Department of Psychiatry, University of Oxford, Oxford, UK.
| | - John R Geddes
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Margot Kushel
- University of California San Francisco/San Francisco General Hospital, San Francisco, CA, USA
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Chong MT, Yamaki J, Harwood M, d'Assalenaux R, Rosenberg E, Aruoma O, Bishayee A. Assessing health conditions and medication use among the homeless community in Long Beach, California. J Res Pharm Pract 2014; 3:56-61. [PMID: 25114938 PMCID: PMC4124681 DOI: 10.4103/2279-042x.137073] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective: Persons experiencing homelessness are a vulnerable population and are at increased risk for morbidity and all-cause mortality compared to the general population. This study sought to evaluate medication use, regular physician visits, and identify health conditions among the homeless population of Long Beach, California. Methods: Two “brown bag” medication review events were held at homeless shelters in the Long Beach area. Demographic information, medication use, and comorbid disease states were obtained through surveys. Findings: Three-fourths of the cohort (95 participants) consisted of males, and the average age of participants was 48 years. Psychiatric disorders and cardiovascular disease were the most common disease states reported at 32% and 46%, respectively and so were medications used in treating these chronic diseases. Medication adherence was found to be a significant problem in this population, where more than 30% of patients were nonadherent to medications for chronic diseases. Furthermore, foot problems, hearing and vision difficulties constitute the most commonly overlooked health problems within the homeless population. Conclusion: Based on this and other similar finding, we must accept that the homeless represent a vulnerable population, and that because of this fact, more programs should be focused at improving availability and access to health care among the homeless. Regarding the high number of reported health problems in the study, more studies are needed and more studies should incorporate screening for foot, hearing, and vision issues, both to increase awareness and to provide an opportunity for devising possible solutions to these highly preventable conditions.
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Affiliation(s)
- Mok Thoong Chong
- Department of Clinical Sciences, American University of Health Sciences, Signal Hill, CA 90755, USA
| | - Jason Yamaki
- Department of Clinical Sciences, American University of Health Sciences, Signal Hill, CA 90755, USA ; Department of Pharmacy Practice, Chapman University, Orange, Irvine, CA 92618, USA
| | - Megan Harwood
- Department of Clinical Sciences, American University of Health Sciences, Signal Hill, CA 90755, USA
| | - Richard d'Assalenaux
- Department of Clinical Sciences, American University of Health Sciences, Signal Hill, CA 90755, USA
| | - Ettie Rosenberg
- Department of Clinical Sciences, American University of Health Sciences, Signal Hill, CA 90755, USA
| | - Okezie Aruoma
- Department of Pharmaceutical Sciences, American University of Health Sciences, Signal Hill, CA 90755, USA
| | - Anupam Bishayee
- Department of Pharmaceutical Sciences, American University of Health Sciences, Signal Hill, CA 90755, USA
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